Dr Prakash Amte carried out vasectomies on Maoists in Gadchiroli


Ashutosh Bhardwaj Posted online: Mon Dec 03 2012
Gadchiroli : Magsasay award winner Dr Prakash Amte, son of legendary social activist Baba Amte, has conducted vasectomy surgery on Maoists at his community centre in Maharashtra’s Gadchiroli district. But he has said that he only did his duty as a doctor and never helped or intended to help the extremists through the procedure that has become controversial.Surrendered Maoists have often said that they were forced to undergo sterilisation by their leaders but top Maoists have denied this and termed it as police propaganda. Chhattisgarh police have termed this operation as the “greatest violation of human rights”.

The Indian Express reported in October that three ex-Maoists underwent reverse vasectomy surgeries as they wanted to become fathers and live a normal family life. According to them, nearly 40 Maoists have undergone vasectomy at Amte’s

Lok Biradari Prakalp in Hemalkasa village so far and they include some top leaders and even a member of the Central Committee of CPI (Maoist).

The Indian Express has details of some of these Maoists but is withholding their names to protect their identity.

Amte admits to have conducted the operations but says he only performed his duty as a doctor and medically, it was less risky compared to abortion. Also, sometimes he was not aware of the identity of those who came for the surgery, he added.

“Several tribals in the area approach me for vasectomy or tubectomy. It becomes difficult to ascertain their identity. I opt for vasectomy as it was safer. Also, Maoists came to me for abortion of their wives, and vasectomy of their cadres. Abortion was risky for women, it endangered their life,” he told The Indian Express. “There was also a possibility that if we conduct abortion once, they may come again for another abortion of the same woman. It involved great health risk for her, so I opted for the lesser evil — vasectomy. Also, I knew vasectomy was reversible.”

Amte, however, makes it clear that he never helped or intended to help Maoists. “By conducting vasectomy, at no point of time I helped Maoists or their movement. I only performed my duty as a doctor on purely humanitarian grounds. I have provided medicare to thousands of tribals in the area,” he said.

Hemalkasa, just a few kilometres outside the Abujhmaad forest, is a remote tribal village bordering Chhattisgarh and Andhra Pradesh, 175 km from the Gadchiroli district headquarters. Baba Amte set up a community project, Lok Biradari Prakalp, in the village in 1973. A year later, Prakash quit his masters in surgery course, opened a medical centre in a hut and settled down there with his doctor wife Mandakini.

Starting in the 1980s, the region became a stronghold of the Maoists. The extremists would visit the Prakalp for medicare and sometimes they also sought vasectomy surgeries for their cadres. A few Maoists said the operation was conducted by Amte himself. The Maoists who underwent the surgery at Hemalkasa included teenagers. “I was only 18 when I was sterilised,” one of them told The Indian Express.

Amte’s clinic is the first and only choice for tribals living in an area spread over hundreds of square kilometres and until a few decades ago, there was no government health centre in the vicinity. Besides his wife, Amte’s two sons and daughters-in-law also live in the Prakalp, a small commune the family has formed and one which is highly respected by the locals.

While Baba Amte won the Magsaysay in 1985, Prakash and his wife won it in 2008 for “enhancing the capacity of the Madia Gonds through healing and teaching and other compassionate interventions”. It is the only instance in India where two relatives of a family have won the ‘Nobel of Asia’.

When Amte came to Hemalkasa, it did not have roads, electricity and schools. Today, the Prakalp treats nearly 50,000 patients every year, a third of them from neighbouring Chhattisgarh and 5,000 from Andhra Pradesh and almost all of them tribals. Besides, it also has a residential school with 650 children and an animal rescue centre.

 

#India- #Abbott suspends giving gifts to doctors #goodnews #medicalethics


 

 

 

 

By Frederik Joelving

 

NEW YORK | Tue Oct 16, 2012 6:03pm EDT

 

(Reuters Health) – Abbott Laboratories Inc has instructed its sales representatives in India not to give gifts to doctors, who are prohibited by local law from accepting them, a practice that has been used as a bargaining chip by companies wanting a piece of the country’s burgeoning healthcare market.

 

According to an internal email dated October 11 from Sudarshan Jain, managing director of Abbott Healthcare Pvt. Ltd, the gift-giving has been temporarily suspended.

 

“Only Abbott-approved clinical/scientific literature may be distributed to current and potential customers,” said the email, which was reviewed by Reuters on Tuesday. “No brand reminders or therapy reminders in your possession should be given to any current and potential customer and no further brand reminders or therapy reminders should be ordered.”

 

Accepting gifts or travel arrangements from drugmakers is against the law in India, but enforcement is inconsistent.

 

Public health experts say gift-giving leads to dangerous overprescribing and unnecessary use of expensive medications when cheaper versions are available. That can be a significant burden for the 400 million people in India who live on less than $1.25 a day.

 

A sales representative with Abbott Healthcare told Reuters that therapy reminders are low-value items such as pens, whereas brand reminders refer to electrical appliances and other pricier merchandise.

 

The representative, who spoke on condition of anonymity, said he was not worried about his job getting harder without the gifts, but, he quipped, it would certainly make his bag lighter.

 

As multinational drug companies ramp up investments in emerging markets to realize billions of dollars in annual sales, they have faced increased scrutiny from the United States and European governments. U.S. authorities are currently probing a number of leading global drugmakers for kickbacks and bribery overseas.

 

A Reuters investigation in September showed Abbott’s Indian subsidiaries plied doctors with scanners, vacuum cleaners, coffee makers and similar items in return for prescribing the company’s drugs to patients. Sales representatives were shown lists of gifts in strategy guides issued by the company.

 

In August, Pfizer Inc paid $60.2 million to settle a U.S. probe involving illegal payments to win business overseas, including kickbacks such as cellphones and tea sets given to doctors in China. Last year, Johnson & Johnson agreed to pay $70 million to settle U.S. charges under the Foreign Corrupt Practices Act (FCPA) that it had bribed healthcare providers in Greece, Poland and Romania.

 

Scott Davies, a spokesman for Chicago-based Abbott Labs, confirmed the decision but declined to say what had prompted the move. He said he was not aware of any inquiries from regulators about the company’s dealings in India.

 

“This is an internal action,” he told Reuters. “We are suspending that brand reminder program while we review it.”

 

Davies said the suspension encompasses Abbott Healthcare and Abbott True Care, but did not have information on whether other Indian subsidiaries would continue the practice. He declined to address travel payments.

 

(Editing by Ivan Oransky, Michele Gershberg, Maureen Bavdek and Claudia Parsons)

 

 

UK denies right-to-die legal challenge


 

BRITAIN ST.

BRITAIN ST. (Photo credit: marc falardeau)

 

 

MARIA CHENG | August 16, 2012 06:30 PM EST | AP

 


 

LONDON — Britain‘s High Court on Thursday rejected an attempt by a man who has locked-in syndrome to overturn the country’s euthanasia law by refusing to legally allow doctors to end his life.

Tony Nicklinson had a stroke in 2005 that left him unable to speak or move below his neck. He requires constant care and communicates mostly by blinking, although his mind has remained unaffected and his condition is not terminal.

In January, the 58-year-old asked the High Court to declare that any doctor who kills him with his consent will not be charged with murder.

The High Court ruled that challenges from Nicklinson and another man named only as Martin to allow others to help them die without being prosecuted were a matter for Parliament to decide.

Nicklinson said he was “devastated and heartbroken” and planned to appeal the decision.

“I am saddened that the law wants to condemn me to a life of increasing indignity and misery,” he said in a statement.

Martin, 47, also has locked-in syndrome and asked for the court to allow professionals to help him die either by withholding food and water or by helping him go to a clinic in Switzerland to die. His wife said she respects his wishes, but does not want to help kill him.

Locked-in syndrome is a rare neurological disorder where patients are completely paralyzed, and only able to blink. Patients are conscious and don’t have any intellectual problems, but they are unable to speak or move.

The judges wrote that they were both “tragic cases,” but said to allow euthanasia as a possible defense to murder “would usurp the proper role of Parliament.”

Nicklinson had argued that British law violated his right to “private and family life” as guaranteed by the European Convention on Human Rights, on the grounds that being able to choose how to die is a matter of personal autonomy. He has previously described his life as “a living nightmare.”

Legal experts weren’t surprised by the ruling.

“This is a really slippery case,” said Richard Huxtable, deputy director of the Ethics in Medicine department at Bristol University. “Although the courts have been willing to look at guidance around assisted suicide, this is about as far as they have been willing to go.

“The feeling seems to be that only Parliament could give adequate thought to what sort of law should be in place and the safeguards required.”

In Europe, only Belgium, Luxembourg and the Netherlands allow euthanasia. Switzerland allows assisted suicide and is the only country that helps foreigners die at a clinic near Zurich.

“It’s very clear courts are unwilling to make the radical shift in our understanding of murder by allowing euthanasia,” said Arthur Caplan, director of medical ethics at New York University’s Langone Medical Center.

“But they did leave a small door open for prosecutorial discretion,” he said, pointing out the judges acknowledged that the decision to prosecute people who helped others to die were not always straightforward.

Britain’s top prosecutor has previously said that people who help loved ones commit suicide won’t necessarily be charged with murder.

Caplan said the British cases were a major departure from past euthanasia debates because neither man is terminally ill.

“Most of the cases which triggered legislation in the past were about dying people and their quality of life,” he said. “We will see more of these discussions as people live longer and we decide what to do about those who are severely impaired.”

Nicklinson said he hoped the courts would grant him another hearing later this year. Experts said he could take his case to the Supreme Court or to the European Court of Human Rights in Strasbourg.

 

After Chhattisgarh its Bihar- illegal hysterectomy on 14-yr-olds #VAW # Reproductiverights


 

In Bihar,

illegal hysterectomy — an operation to remove the uterus.

Numerous cases of forced surgeries came to light in Samastipur district following a probe by district magistrate Kundan Kumar. The victims were sometimes girls as young as 12 to 14-year-olds.

There were a number of fake cases too, and in some of them, the operation was shown to have been conducted on men.https://i2.wp.com/www.hindustantimes.com/Images/Popup/2012/8/09_08_12-metro10.jpg

“It is not only a case of fraud but a gross violation of medical ethics,” said Kumar, who held a health camp as part of the probe. At the camp, ultrasound tests were conducted on over 3,000 women.

The report, which was finalised on Wednesday, indicts 16 nursing homes in Samastipur, all of which have been issued a showcause notice. The matter also found resonance in the state assembly, where the opposition put the Nitish Kumar government on the mat.

The probe was held when the insurance company, ICICI Lombard, raised an alarm after receiving a bill of a whopping Rs. 17 crore from the 16 nursing homes. A claim of Rs. 10,000 can be made for a single hysterectomy.

“At the camp, we received many complaints that the surgeries were forced,” Kumar said. “Private nursing homes even scared women with prognosis of grave medical complications, like cancer, if the uteruses were not removed.”

State labour minister Janardan Singh Sigriwal — whose department is the nodal agency for the scheme — insisted that  there has been no irregularity. It was decided that the call attention committee of the assembly will probe the matte

 

 

Doctors’ freebies to be Taxed :-) #Goodnews


 

C Unnikrishnan, TNN Aug 7, 2012, 03.56AM IST

MUMBAI: The income-tax (I-T) department will tax the amount pharmaceutical and allied health sector industries spend on freebies for medical practitioners and their professional associations. Those who accept the freebies will also be taxed.

The decision follows an amendment to Medical Council of India regulations banning doctors and their associations from accepting freebies. The freebies include money, travel facilities and hospitality extended by pharma firms and makers of medical devices and ‘nutraceuticals’.

The Central Board of Direct Taxes August 1 circular says the department has come across such instances and a senior pharma company official admitted companies do it to advance sales. He said a company was planning to take around 80 doctors from across the country on a full-expenses paid foreign trip for a ‘seminar’.

The I-T department grants an exemption to money spent on business promotion. It accepts firms’ claims and allows deduction. An official said, “Pharma firms cannot claim the benefit as regulations prohibit it. If we can prove the company extended freebies to doctors, they have to pay taxes. Those who receive freebies will also have to pay a tax on the gift’s value or money spent on it. If a doctor gets a fridge, its market value will be treated as income.”

Chandra Mohan Gulati, a drug regulatory expert, said it was a great first step but “let it not be the last”. He felt doctors should be told to mention details of their ‘gifts’. In 2009, MCI had set guidelines for doctors vis-a-vis pharmaceutical companies.

Ranga Iyer, who used to head Wyeth and the OPPI (Organization of Pharmaceutical Producers of India), said, “We must look at the IT Act changes in isolation. The need is for ethical marketing practices for pharmaceutical firms and we support any such move.”

Dr Arun Bal of the Association for Consumers’ Action on Safety & Health an NGO that works for patients’ rights, said, “This follows attempts by MCI and the government to bring about self-regulation among doctors and the industry.”

(With inputs from Malathy Iyer)

 

A long shadow: Nazi doctors, moral vulnerability and contemporary medical culture #SundayReading


 

Animated map showing German and Axis allies' c...

Animated map showing German and Axis allies’ conquests in Europe throughout World War II (Photo credit: Wikipedia)

 

ABSTRACT
More than 7% of all German physicians became members of the Nazi SS during World War II, compared
with less than 1% of the general population. In so doing,these doctors willingly participated in genocide,
something that should have been antithetical to the values of their chosen profession. The participation of
physicians in torture and murder both before and after World War II is a disturbing legacy seldom discussed in medical school, and underrecognised in contemporary medicine. Is there something inherent in being
a physician that promotes a transition from healer to murderer? With this historical background in mind, the
author, a medical student, defines and reflects upon moral vulnerabilities still endemic to contemporary
medical culture.

 

Read full article here genocide

 

 

 

Follow professional ethics, doctors urged #SJ #Aamir Khan


Aarti Dhar, The Hindu, June 13

Aamir Khan’s “Satyamev Jayate” has drawn sharp criticism from Indian Medical Association

Taking forward the debate on commercialisation of health, initiated by actor Aamir Khan in his television show “Satyamev Jayate” that drew sharp criticism from the Indian Medical Association (IMA), health activists have said distortions in medical practices, induced by unregulated commercialisation, have become systemic problems.

In an open letter to the IMA, which has sought an apology from Mr. Khan for “maligning” the entire profession because of a few errant doctors, the Medico Friend Circle (MFC) and the Forum for Medical Ethics Society (FMES) have sought self-regulation by medical professionals and active involvement of citizens in the process, than bureaucratic regulation, to ensure rational care and patients’ rights.

‘Uphold dignity of medical profession’

They said: “We very much appreciate that you want to uphold the dignity of the medical profession. However, we feel that denying or minimising the importance of the issues raised by the show and demanding an apology fromAamir Khan is definitely not the most appropriate way of upholding the dignity of doctors. Instead, the IMA should seriously try to reverse the process of health system reforms for eliminating the distortions in medical practice. This would be immensely beneficial to patients and would also raise the dignity of the medical profession manifold. Instead of ‘silencing the messenger,’ we need to listen to the main message of the show and take steps to address problems which are very real.”

The letter raised questions on cut practice and commissions, irrationality in investigations and surgical practices, influence of the pharmaceutical industry on doctors, and inflation of patient bills as a consequence to all these practices.

“This has resulted in massive problems related to both cost and quality of medicare for people. Besides the evidence from various studies on Caesarean section rates, injection practices, prevalence of hysterectomies and sex selective abortions are admitted to by most practicing doctors, and are not limited to a few isolated individuals,” the letter said.

“As good physicians, if we go beyond addressing the ‘symptoms’ and make a ‘comprehensive diagnosis,’ it will be obvious that all these disturbing features are due to a system of unregulated commercialisation of medical care, which has emerged over the last few decades.

Large number of discontented individuals, doctors as well as ordinary citizens, need to come together and start changing this system through a large scale social process,” the MFC and FMES said.

*An open letter to office bearers of IMA*

To,

The National office bearers,

Indian Medical Association

Dear IMA office bearers,

We are writing this letter in context of the apology recently demanded by
IMA from Aamir Khan, regarding the episode on 27 May 2012 of his show
‘Satyamev Jayate’ (SJ) dealing with certain practices of the medical
profession. We write to you as members of Medico Friend Circle (MFC,
http://www.mfcindia.org) and Forum for Medical Ethics Society (FMES). MFC is a
nation-wide 39 year old platform of pro–people doctors and health
professionals, scientists and social activists, involved in improving
health care, especially for the deprived sections of people. FMES is an
association of doctors and health professionals which has been actively
campaigning for reform in the healthcare system and medical education, and
has been publishing the Indian Journal of Medical Ethics since 1995.

We very much appreciate that you want to uphold the dignity of the medical
profession. However we feel that denying or minimising the importance of
the issues raised by this show and demanding an apology from Aamir Khan is
definitely not the most appropriate way of upholding the dignity of
doctors. Instead, IMA should seriously try to reverse the current
widespread unregulated commercialisation of health care in India, and
should contribute to the process of health system reforms for eliminating
the distortions in medical practice. This would be immensely beneficial to
patients and would also raise the dignity of the medical profession
manifold. Instead of ‘silencing the messenger’, we need to listen to the
main message of this show and take steps to address problems which are very
real.

We would not go into the details of the content and form of this show. We
would rather point out that the critical issues raised regarding cut
practice and commissions, irrationality in investigations and surgical
practices, distorting influence of pharma industry on prescribing by
doctors, and inflation of patient bills consequent to all of these, are
extremely widespread. This has resulted in massive problems related to both
cost and quality of medical care for the people. There is no point in
dismissing these issues as just being related to a few ‘black sheep’ in the
profession. Besides the evidence from various studies on cesarean section
rates, injection practices, prevalence of hysterectomies and sex selective
abortions etc., most practicing doctors admit in private that malpractices
are a pervasive trend, not limited to a few isolated individuals. In
fact *distortions
in medical practice induced by unregulated commercialisation have become
systemic problems*.

Given this reality, let us move beyond the ‘few rotten eggs’ type of
defensive arguments focussed on individuals, and look at the systemic
problems which include-

· Astronomically high ‘donations’ charged by mushrooming capitation fee
medical colleges are a major influence which is pushing crass
commercialisation of medical practice, besides placing medical education
beyond the reach of many deserving poor and middle class students.

· Widespread cut practice, intense competition and defensive medicine
are causing dissatisfaction among many doctors, not only their patients.

· Pressures are imposed on doctors by hospitals, inducing them to advise
more than necessary investigations, procedures, intensive care admissions,
hospital stays.

· There are continuous tensions between doctors and patients over
payment issues, and even occasional outbreaks of violence against
hospitals.

These are serious problems going beyond just a few individuals, which are a
product of the increasingly commercialised, market oriented nature of
medical care in India today.

As good physicians, if we go beyond just addressing the ‘symptoms’ and make
a ‘comprehensive diagnosis’, it will be obvious that *all these disturbing
features are due to a system of unregulated commercialisation of medical
care*, which has emerged over the last few decades. Instead of being
foremost healers and protectors of their patient’s health, doctors are
increasingly forced to become hard-nosed businessmen, often in order to
repay large scale loans, to ensure their practice, and to remain ‘in the
system’ despite the fact that many would not have liked to depart from
their principles. In this situation, the increasing numbers of ‘black
sheep’ (and much larger numbers of ‘grey sheep’) are the inevitable
products of this system. Of course there is a role for individual
responsibility, but such an entrenched system cannot be changed just by
giving moral science lectures to individual doctors, by asking them to
follow rational principles in isolation. Instead of this, large numbers of
discontented individuals, *doctors as well as ordinary citizens, need to
come together and start changing this system through a large scale social
process.*

Of course, commercialisation and linked distortions are seen in all
professions. But doctors’ organizations are best placed to reform the
medical profession and health care sector, thereby contributing to wider
social reform. In fact IMA’s stated objectives include “improvement of
Public Health and Medical Education in India”. Hence we would suggest that
instead of rubbishing the SJ episode and ignoring its main message, IMA
should treat this as a ‘wake-up call’ for the medical profession as well as
for wider society, and we should all start a process at two levels. We need
to initiate *social regulation of medical practice* (which would include
elements of self-regulation by the profession and active involvement of
citizens, not just bureaucratic regulation) to ensure rational care and
patients rights. Further linked to this, we need to move from a
market-centred model of health care, towards a *socialised system of
universal health care*.

This letter will not go into details of how such social regulation of
medical practice and further, a system for universal health care (UHC)
might be developed in India, which could ensure decent and secure
livelihood for all doctors (though not super-profits for any!) and access
to good quality, free health care for all residents of the country. IMA
office bearers would be aware of UHC systems which are successfully working
in a wide diversity of contexts: developed countries like Canada, Australia
and Scandinavian countries, as well as developing countries like Brazil and
Thailand. Of course we will need to evolve a UHC model that is appropriate
to Indian conditions which will require broad based debate and inputs from
all stakeholders, especially from the medical profession. This process
has already been initiated by the High Level Expert Group on Universal
Health Coverage (HLEG-UHC) appointed by the Planning Commission, which has
published a detailed report which would be taken into account while
developing the upcoming 12th Five year plan. We may differ of the details
and specifics of the model, but we need to accept that Universal Health
Care is now emerging on the national agenda, and we should all start
engaging with this process.

Such a UHC system would eliminate widespread commercialisation, cut-throat
competition and insecurity among the majority of doctors, while ensuring
them a decent income and basic security. The price of not moving towards
such a system is colossal, not only for patients from all classes of
society, but also for the vast majority of doctors who would like to
practice their profession nobly and rationally, but are being sucked into a
money-centred system which trumps humane principles and rational practices.
The potential rewards of such an alternative health care system would be
similarly enormous for our entire country of 1.2 billion people, including
our doctors who could once again become respected and honored
professionals, instead of presently being often viewed by people with
suspicion and even resentment.

In short, the time has come to do some genuine introspection and
alternative thinking, and to address the widespread problems instead of
denying them. On the lines of the call for ‘Physician, heal thyself!’, the
time has come to say – ‘Physicians, heal thy system!’

Yours Sincerely,

Executive committee, Medico Friend Circle

Managing committee, Forum for Medical Ethics Society

One-sided deal: Hospitals get but don’t give back


Hospital, Bandra

Hospital, Bandra (Photo credit: Wikipedia)

Grants, concessions and exemptions given to the hospitals far exceed the cost of free treatment they are asked to carry out

Jyoti Shelar and Lata Mishra, in Mumbaimirror

Posted On Thursday, April 26, 2012

The death of accident victim Reena Kutekar, whose husband Ram desperately hunted for a hospital that would save her life, has brought into focus how badly poor patients are treated in private medical facilities across the city.

Reena was first taken to Vile Parle’s Nanavati Hospital, where the authorities refused to take her into the ICU because Ram could not furnish the Rs 25,000 required for admission.

The story in most other hospitals in the city is alarmingly similar: though they are required by law to treat a certain number of economically backward patients, most people come away empty handed in their time of need.

The contention of the hospitals – from Jaslok to Breach Candy, from Lilavati to Hinduja – is that taking care of poor patients is a huge burden on them, and that they are asked to provide free treatment for nothing in return.

What these hospitals fail to reveal, however, is that the grants and concessions they are given by the government far exceed the cost of free treatment they are being asked to carry out. Running as charitable public trusts, their list of unaccounted-for exemptions is staggering:

1. Cheap land

If any charitable trust wants government land to build a hospital, it is charged only one-tenth of the market value in the island city, and one-twentieth of the market value in the suburbs. If the land is on lease, the price can be as low as Re 1 per square foot per year.

“Several facilities, such as Jaslok, Hinduja and Bombay Hospital, are on government land given to them on a Re 1 lease. Now they’re earning crores annually but still make excuses when it comes to treating poor patients,” said advocate Sanjeev Punalekar, who had filed a PIL on the issue in 2004.

2. Extra FSI

While the rest of the city’s commercial establishments have to make do with an Floor Space Index of 1.33 to 2, public trust hospitals get an additional FSI of up to 5.32 in the island city and up to 5 in the suburbs.

The FSI determines the height of the structure, which in turn translates into more room for patients, and more business. But the taller hospitals have hardly been of help to poor patients.

“The additional FSI and all other rebates come from the government. The rest of the money comes from patients. Ultimately, it is the government and public money that adds up to the surplus funds of hospitals,” said health activist Leni Chaudhary. “Then why not ensure that poor patients get treated?”

When contacted, Dr Pramod Lele, the CEO of the Mahim’s Hinduja Hospital, admitted that additional FSI proved beneficial in increasing the hospital’s “bed- strength”, but contented that they were asked to pay a premium for it. Not the best argument considering the demand-supply ratio of hospital rooms guarantees that this money is easily recovered.

3. Income Tax rebate

The exact rate of exemption varies from hospital to hospital, depending on how much money it makes. On average, however, 85 per cent of a public trust hospital’s income is exempt from tax. Even the remaining 15 per cent can be set aside as a corpus fund, ensuring that most hospitals have to pay no tax at all. The only catch is that anything accumulated above this 15 per cent in their account is taxable. Hospitals registered as research institutes are given similar concessions.

4. No Octroi

While Octroi rates in Maharashtra are inordinately high, hospitals are exempted from any additional tax for transporting equipment and machinery. In 2003, the BMC withdrew Octroi exemption from a few hospitals for not doing enough charity work. When contacted, a senior doctor from Lilavati hospital agreed that there had been several complaints made to the Charity Commissioner about norms being flouted, which had resulted in some rebates being pulled back for certain hospitals.

5. Duty free

All public trust hospitals are exempted from customs duty on imported machinery and medical equipment, as opposed to 10 per cent for all non-public-trust hospitals. When contacted, Customs officials said machinery and medicines from abroad were one of the most common items brought into the country. “As per the law, we clear them immediately,” an officer said.

6. Cheap Medicines

Hospitals procure generic drugs at nominal costs, and several medicines which are made available by the government under various programmes such as Tuberculosis and Malaria eradication are given to them at a fraction of the cost. However, health experts point out, that these drugs are then sold to patients at the market rate.

7. Low water and electricity rates

Despite being commercial establishments, hospitals are charged residential tariffs for water and electricity, which in itself is a huge benefit. The Residential rate for water per 1,000 litres, for example, is Rs 2.25 as opposed to Rs 38 for commercial use.

 What hospitals are supposed to do 

According to a Supreme Court judgment, charitable hospitals must admit a patient brought in an emergency and provide “essential medical facilities” until stabilisation. Transportation to a public hospital should be arranged, if necessary, and no deposit should be asked for.

Each hospital has to transfer 2 per cent of its income to an Indigent Patients Fund (IPF). The hospital has to reserve 10% of its beds for indigent patients (annual income less than Rs 25,000) who should be given free treatment.

A further 10% of its should be reserved for economically weak patients (annual income less than Rs 50,000) who should be treated at concessional rates. At the time of admission, all a patient has to provide is a certificate from the Tehsildar or a ration card or BPL card.

Drug trials : Madhya Pradesh chief secretary fails to report to NHRC


 Feb1, 2012, Asish Gaur TOI

INDORE : The National Human Rights Commission (NHRC)’s order to the Madhya Pradesh chief secretary to report to it the details of the controversial human drug trials in Indore, has run into a procedural wall.

Taking suo motu cognisance of a TOI report on drug trials conducted on 233 patients of the government-run mental hospital attached to the Mahatma Gandhi Medical College in Indore, the NHRC had asked the chief secretary to furnish the details by last Tuesday. But the latter has not obliged, maintaining that the laws allow the concerned doctors to keep all details of the trials confidential.

Forty two of these patients were given Dapoxetine, a drug to cure premature ejaculation. However, an earlier report of the Drug Controller General of India (DCGI) had said they were not mentally ill, but were seeking psychiatric help for premature ejaculation.

Among other points. the NHRC had also specifically asked the MP chief secretary to report if the doctors had followed Indian Council of Medical Research (ICMR) guidelines, while conducting the trials on the basis of approval obtained from independent ethics committees attached to private hospitals _ bypassing the medical college’s own institutional ethics committee.

The chief secretary, Avni Vaishya, told TOI that he was not in a position to submit the report.”The doctors have kept the trial documents under wraps. The details are confidential according to the laws for the conduct of clinical trials. Only central regulatory bodies such as the DCGI or MCI can investigate the matter,” he said.

The NHRC, however, has decided to press the issue. NHRC spokesperson Jaimini Kumar Srivastava said the commission will write to the chief secretary again. “We have not received any communication from the chief secretary as of now. The time allowed to submit report has lapsed. We are going to write again asking to submit the report at the earliest.”

2-FEB-2012

NEW DELHI : Union health minister Ghulam Nabi Azad on Wednesday asked an explanation from the Madhya Pradesh government on the malpractices surrounding the recent clinical trials conducted in Indore.

“Irregularities were found in the clinical trials conducted there and the state government needs to explain what action has been taken against the doctors involved,” he said.

The drug controller general of India (DCGI) had recently issued a stern show cause notice to five doctors of Indore’s Mahatma Gandhi Medical College for not following good clinical trials (GCT) norms, while conducting clinical trials on 241 patients visiting the College’s psychiatry ward.

Notices had also been sent to three companies – Cadilla, Mcure and Intas – to explain the deficiencies at the earliest.

The DCGI has threatened blacklisting of the doctors from all other trials they are involved in if they fail to reply at the earliest. Two hundred and forty one patients in Indore were subjected to clinical trials to check the efficacy of various drugs, including 42 for Dapoxetine, a drug used to cure premature ejaculation.

An independent team of investigators sent by the DCGI submitted its report to the health ministry recently.

The report has cleared the investigators of carrying out the trial on “mentally ill” patients. The investigating team however took serious cognizance to the fact that investigators did not posses with them the original informed consent forms.

The forms were taken away by the sponsors of the trial, “which is a serious offence”.

A ministry official said, “Most of the patients were suffering from erectile dysfunctions and were being treated by psychiatrists from that medical college. That is why they were visiting the psychiatric ward and not because they were suffering from any mental illness.”

“However, show cause notices have been served on the doctors for the serious administrative lapses and deviation from GCT guidelines while carrying out the trial,” the official added.

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